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This paper discusses the management of multisystemic sequelae of perinatal asphyxia. Appropriate intrapartum and subsequent adequate neonatal monitoring are an absolute necessity for the early detection of systemic dysfunctions. Prophylactic and therapeutic measures applicable to the various organ malfunctions are described.
This paper describes the clinical and pathologic sequelae of perinatal asphyxia manifested by 17 neonates treated at Howard University Hospital over an 18-month period. Multiple systemic complications, occurring in 76.5 percent of the patients, were the rule rather than the exception. All vital organs were involved, singly or in combination. Understanding the pathogenesis and extent of these complications is of utmost importance not only to those rendering health care to acutely ill newborns, but also to those responsible for prenatal and maternal intrapartum care.
The authors studied the incidence of late and permanent neurological sequelae of tick-borne encephalitis in the population of the Province of Olsztyn. The investigations were carried out in a group of 103 patients who were affected in the years 1970--1974. The diagnosis was confirmed in all cases with epidemiological, clinical and laboratory investigations and serological evidence of tick-borne encephalitis. It was shown in these studies that tick-borne encephalitis caused development of permanent lesions in the central and peripheral nervous system in 25.3% of cases. It was observed, moreover, that a considerable part of neurological signs found in the acute stage of the disease disappear during hospital treatment but later on after discharge from the hospital the symptoms of nervous system damage reappear and new signs develop which had not been observed in the acute stage. In the light of these studies the authors conclude that a considerable proportion of convalescents have limited physical and intellectual efficiency making impossible their return to their previous work and causing not infrequently permanent loss of working ability which must be kept in mind by physicians from different specialities.
In three of 111 infants born after amniocentesis and in one of 5 fetuses aborted after amniocentesis, which could be examined, small skin lesions or scars were observed. Interpretation as sequelae of needle puncture appears possible, but questionable, particularly since similar lesions were observed in infants born after uncomplicated pregnancy without amniocentesis. The differential diagnosis of a focal dermal hypoplasia or aplasia may be considered, which may be hereditary.
LITIGATION FOR PERSONAL INJURY FOLLOWING ACCIDENTAL TRAUMA IS AN EXPENSIVE AND CONFUSED PROCESS INVOLVING THREE PROTAGONISTS: patient, doctor and lawyer. Although post-traumatic conditions can be elaborately classified, the intrinsic validity of such classifications is often questionable. Current methods of evaluating psychological sequelae of accidental injury are inaccurate and unsatisfactory, partly because of the protagonists' conceptual, motivational and semantic differences. In addition, there is no really satisfactory method of (a) determining and quantifying minor but significant degrees of brain damage, (b) distinguishing these from "post-traumatic neurosis", or (c) determining the relationship between the trauma and subsequent disturbance of function. Increasingly "expert" advice is solicited but owing to the nature of the data and conditions of examination, such advice does little to clarify the underlying problems. Furthermore, doctors are often unable to communicate effectively to the judiciary just how the trauma has affected the patient. Even though certain suggestions for improvement are advanced, the need for comprehensive, longitudinal research is inescapable.
The article discusses the signs and treatment of fractures of the jugal bone. Basing on 141 patients treated in our clinic, a detailed analysis is given of the problems connected with post-traumatic sinusitis maxillaris, as well as the neurological late sequelae of the n. infraorbitalis. Accurate repositioning and fixation of the fragments are essential; the authors give preference to wire suture. No routine revision of the maxillary sinus and decompression of the nerve are necessary.
Intracranial hemorrhage (ICH) is a major problem for the premature infant, occurring in more than one-third of surviving infants weighing less than or equal to 1,500 g at birth. The literature on perinatal ICH, as it relates to neurodevelopment outcome, is briefly reviewed, and preliminary results from our two-year followup of 75 less than or equal to 1,200-g infants are summarized. An analysis of pathophysiology, diagnosis, classification, and followup indicates that risk for ICH and its sequelae increases as gestational age and birth weight decrease. Hydrocephalus apparently no longer presents significant risk beyond that conveyed by the original hemorrhage. However, persistent posthemorrhagic ventriculomegaly and/or periventricular abnormalities serve as significant "markers" of risk for neuromotor delay through two years of age. In contrast, recovery of normal ventricular morphology by term gestational age apparently indexes a degree of recovery from ICH and predicts a more normal developmental outcome through the first two postnatal years.
Early diagnosis of pelvic inflammatory disease (PID) and treatment with appropriate doses and types of antibiotics that take into account the polymicrobial etiology of this condition are essential to prevent future infertility. That PID frequently is subacute or relatively asymptomatic argues in favor of a more liberal use of laparoscopy in the diagnosis of this condition. The sequelae of PID that cause infertility can be assessed with the judicious use of hysterosalpingography and laparoscopy. These procedures are complementary. Hysteroscopy is of more limited value. Operative laparoscopy has proven to be useful in restoring fertility in appropriately selected cases. In many instances laparotomy can be replaced successfully with laparoscopic procedures, which offer many advantages. The introduction of microsurgery has significantly improved the success rate associated with reconstructive infertility operations. The successes associated with a new therapeutic modality, in vitro fertilization (IVF) and embryo transfer (ET), although modest, have been improving in the past three years. Reconstructive microsurgery and IVF/ET are complementary treatments for infertility. A thorough investigation of the infertile couple, with meticulous attention given to the various fertility parameters, individualization and a rational approach to treatment with these two modalities will undoubtedly improve the overall results.
Streptococcal abscesses were experimentally induced in skin of swine as a sequela to swinepox. Swinepox lesions were more uniform in distribution when infection was induced by IV injection of swinepox virus than when induced by lice (Haematopinus suis) or scarification of skin. The incubation period for swinepox was between 10 and 14 days when virus was administered IV. Cutaneous abscesses developed in swine given IV injection of streptococci 10 and 14 days after they were injected with swinepox virus, but not when they were given the streptococci 7 days after virus injection or simultaneously with virus injection. Abscesses did not develop when streptococci were applied topically to swinepox lesions.
In this clinico-experimental work data are presented concerning the blood plasma insulin activity in mature fetuses and neonates in asphyxia; the influence of insulin on the course of hypoxia and elimination of its sequelae under experimental conditions on the newborn and sexually mature rats was also noted. The blood plasma insulin activity proved to increase in the neonates born of mothers with normally coursing pregnancy. A statistically significant reduction of the insulin activity was noted in neonates whose mothers suffered from toxemia of the second half of pregnancy. The death of fetuses and neonates was accompanied by a marked reduction of the blood plasma insulin activity. Preliminary administration of insulin increased the tolerance of experimental animals to hypoxia. Administration of insulin at the period of normalization of physiological functions after hypoxia produced a positive influence on the animal revival. Data are presented on the mechanism of insulin action in hypoxia.
There are not yet any ascertained results concerning the prognosis of the non-A/non-B hepatitis not depending on transfusion. In an identical source of infection meanwhile several working teams in the GDR by means of long-term observations for three years control groups of women able to propagate who were incubated by a hepatitis C-virus (of the non-A/non-B group of the hepatotropic viruses), so that first evidence on posthepatitic sequelae after hepatitis C is possible. Of 115 women who were treated with anti-D-globulin contaminated with C virus 57 women fell ill (= 49.5%). Of them 39 patients (3 68.4%) were cured after 3 years, 7 patients (6 12.3%) showed the signs of a residual hepatitis, 10 patients (3 17.5%) showed a chronically persisting and 1 patient (= 1.75%) a chronically active hepatitis. The results presented are compared to those of other working teams of our country.
The goal of this study is to appreciate the early and late sequelae caused by Chlorine Gas. 186 exposed patients have been admitted to our unit since 1962-119 had functional respiratory explorations (FRE) with an analysis of blood gases, 79 underwent a study of carbon monoxide transfer. The results are in accordance with the literature for example 25% of the CO transfer test were pathological. 56 occupationally exposed subjects having had at least three acute episodes of exposure have been compared to 197 control subjects (groups were classed in function of age, tobacco intake, and pulmonary antecedent). Chlorine exposure even when frequent has no the influence on the FRE results or the appearance of pulmonary pathology. The pre-existence of a pulmonary disease doesn't affect the prognosis.
The psychosocial sequelae of treatment by Milwaukee brace were investigated in 38 girls. These girls were found to cope well after an initial critical period. Only minor disturbances of body image and sexual attitudes were observed. It seems that except for individual severe cases, no specific psychiatric intervention is needed in those patients, and a competent orthopedic surgeon could manage all the psychological aspects.
Occult traumatic lesions of the cervical spine usually involve the smaller, posterior elements of the vertebrae. Chronic neck pain associated with these lesions is intermittent and of variable severity, but with patterns that are fairly characteristic of the osseous lesions. Similarly, the long-term radiographic sequelae occur in fairly predictable patterns. The original osseous injury characteristically involves a fracture deformity and frequently some instability. There is a closed five point suspension system at each of the levels of the lower cervical spine, so that each of these five points is stressed whenever any one of them is deformed. Thus there follows bilateral hypertrophic changes and disc deterioration. Satellite changes also occur. The original deformity usually leads to rotation at the level of the lesion, cervical malalignment, and muscle imbalance. Therefrom the osseous and disc changes associated with chronic torticollis may occur, as well as distant instabilities.
A total of 32,177 female sterilizations performed by different surgical procedures under different time scales were studied with reference to the effectiveness of the procedure and immediate, short-term and long-term complications arising out of the procedure. The results of immediate sequelae only are being reported in this article. Laparoscopic technique was employed in 7.1% of cases, culdotomy in 6.9% and minilaparotomy/laparotomy in the remaining 86% of cases. The findings indicate that minilaparotomy performed in the postpartum period is most suitable and safe for Indian women under existing conditions. Complications including mortality were least when the operation was performed as a minilaparotomy in the early postpartum period. Visceral injuries were maximum with the laparoscopic technique (10.45/1000). Mortality of interval sterilization was higher than that of postpartum sterilization (6.19/10,000 Vs 0.7/10,000) but this rate is lower than the current maternal mortality of the country (41.76/10,000). In view of the results obtained, it appears that minilaparotomy will continue to be "the method" of choice on a mass scale.
This article describes the psychological sequelae to disasters with reference to the 1983 'Ash Wednesday bushfires' in the Dandenong mountains of Victoria. Psychological reactions during and after the disaster were varied. The intervention of a mental health team is described.
Two siblings with classic transferase deficiency galactosemia that was detected at birth have been treated with lactose restriction since the neonatal period. Both patients developed a unique and progressive neurologic syndrome of mental retardation, tremor, and ataxia. Careful review of the family history and medical records, the absence of metabolic disturbances other than those related to galactosemia, and the aggregate physical findings and neurodiagnostic studies ruled out other neurologic disorders in these siblings. It is therefore proposed that these patients represent a subgroup of transferase-deficient galactosemic patients, who develop characteristic neurologic sequelae with conventional dietary management. The existence of this subgroup should be considered in evaluations of therapeutic responses in cohorts of patients with galactosemia. Further, galactosemia should be included in the differential diagnosis of tremor and ataxia in the setting of mental retardation.
Concern for the late formation of strictures at the site of an endoscopic sphincterotomy has delayed the acceptance of this procedure as treatment for choledocholithiasis in otherwise healthy patients. The authors addressed this issue by comparing the biochemical and histologic sequelae of sphincterotomy in 23 dogs with those in 10 sham-operated controls. Twenty-four hours after sphincterotomy, hemorrhagic, edematous mucosa surrounded the incision. Microscopically, there was an acute inflammatory exudate bridging the mucosal surfaces. Mucosal regeneration was sufficient after 1 week to cover the defect caused by the cautery, although some inflammatory changes were still evident. A widely patent sphincterotomy orifice was seen in 15 dogs followed up for 10 weeks. In three dogs, the fibres of the papilla had reunited below the incision, resulting in a choledochoduodenal fistula. Histologically, complete healing of the mucosal surface had occurred with no evidence of scar formation or chronic inflammation. Serum bilirubin and liver enzyme measurements did not show evidence of biliary obstruction due to the sphincterotomy. From the results of our study, there is no evidence to suggest that an endoscopic sphincterotomy is predisposed to late stenosis.